"If you can feel a pulse their BP is at least 90"

[nurseterry]

I need some facts.....I heard this quoted AGAIN just yesterday by a new grad nurse.

I just came from the ENA conference where a lecturer claims this isn't fact

Where did this statement come from

Is it true

Where can I find literature to prove or debunk it...because I am tired of hearing it. Frankly

[Meriwhen, ASN, BSN, MSN, RN]

I've never heard that statement before.

I've felt a pulse in a patient whose BP was 70/36. It wasn't the best pulse in the world but it was palpable. So I wouldn't say it's a true statement all of the time.

[AznMattRN]

I had one of my ER docs tell me that the other week...

[Penelope_Pitstop, BSN, RN]

Disagree.

I've had patients with good pulses and manual blood pressures less than 90 systolic.

Also, just because you have a carotid pulse does NOT mean you're perfusing adequately.

[CrunchRN, ADN, RN]

Is that a radial pulse or?

[Penelope_Pitstop, BSN, RN]

Is that a radial pulse or?

Exactly. Think of all of the pulses a human has. And all of the methods that exist for obtaining blood pressure.

[GilaRRT]

It was and still is used as a general rule of thumb in the Army. The old radial, 80, femoral, 70, carotid, 60 rule. However, I think it is often used and or interpreted incorrectly. Instead of a number, which is inaccurate and ultimately tells us nothing, we should instead focus on more important concepts. Currently, I see the teaching more on the lines of "if a patient has a palpable radial pulse and intact level of consciousness, then their brain is being adequately perfused."

This is much more helpful IMHO, and keeps people from focusing on some imaginary number that may or may not even be real.

[tencat]

Wow, so not true all the time. I had a patient with a 80/45 BP and a pulse of 25 (that I could palpate, by the way), who was still sitting up and conversing, was oriented, etc. I truly don't know why she was still conscious, but you bet your bippy I could feel her pulse. (Listened for 2 full minutes, too just to make sure it was really that low).

[MassED, BSN, RN]

the weaker the pulse (central pulse), the poorer the perfusion.....

[BluegrassRN]

When I took ACLS a while back, our instructor (who is a firefighter/battalion chief, paramedic, and RN) told us that in a code/rapid response situation, a significant number (sorry, can't remember the exact number) of docs and nurses could not locate a carotid pulse on a patient when there was a regular rhythm. We aren't talking PEA.

So, given that info, I wouldn't trust the idea that if they have a pulse, they have an SBP of at least 90, particularly in a stressful situation. Heck, it seems like half my patients have a BMI of 40+. What sort of SBP does a 500 pound, five foot tall woman have to have before I can feel a pulse?!

[BluegrassRN]

Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I (June 1998). "Competence of health professionals to check the carotid pulse". Resuscitation 37 (3): 173-5. doi:10.1016/S0300-9572(98)00055-0. PMID 9715777.

"Abstract

Our objective was to establish the proportion of Emergency Room and Intensive Care doctors and nurses able to locate the carotid pulse in less than 5 s, and identify the variables that influence this ability. The method followed was locating the carotid pulse in a healthy male adult volunteer with normal blood pressure in two situations (stretcher or floor) and with the neck in either a neutral or in an extended position. We recorded the gender, age, and previous training in cardiopulmonary resuscitation (CPR) of each participant and the time spent in detecting the pulse in each of the four possible positions. A model of logistic regression was constructed to determine if the patient's position had any influence on the proportion of health workers capable of finding the pulse within 5 s. The average age of the 72 subjects studied was 33.4 years (SD=6.6); 80% of the participants had CPR training. Thirty-one participants (43.1%; CI 95%, 31.4-55.3%) required more than 5 s to detect the pulse, although only three (4.2%; CI 95%, 0.9-11.7%) required more than 10 s. The variable `no CPR training' was associated with the inability to detect the pulse within 5 s. The detection of the pulse was easier with an extended neck. A significant proportion of nurses and doctors were slow to locate the carotid pulse on a healthy, young volunteer with normal blood pressure. No relation was found between gender or age of the participants. More attention should be given to carotid pulse detection in CPR training."

In case anyone's interested.

[LaurenBoog]

When I first started in the ICU, I took care of a patient with chronic liver and heart problems. She had an extremely low BP....the attending doc started her on pressors which had to be D/C'd because of her heart rate, and they weren't helping anyway. The next morning the intensivist came by and decided that because of her chronic liver problems (portal circulation?), the low BP was the body's attempt to perfuse everything important, and that no matter what interventions we did (short of a liver transplant) her BP was not going to improve. We let her hang out all day with a BP of 75/25....and the intensivist was totally fine with that. The lady was sitting up in a chair, alert, she did not "crash" on us at any point. I don't remember if she had palpable pulses or not.

I guess my point (already stated by other posters) is that knowing what is going on with the patient is sometimes more important that a "number" or "palpable pulses."